PB1870: COVID - 19 IN PATIENTS WITH CHRONIC LYMPHOCYTIC LEUKEMIA: HOSPITAL MORALITY PREDICTORS
Authors: O. Kochneva, E. Baryakh, E. Misyurina, E. Zhelnova, K. Yatskov, Y. Polyakov, K. Kaluzhskaya, T. Chudnova, T. Tolstykh, D. Ivanova
Journal: HemaSphere (2022)

Background: Patients with chronic lymphocytic leukemia (CLL), as the disease progresses and the tumor load increases, are characterized by high susceptibility and severe course of viral infections. The depth of immune dysfunction can be influenced by factors such as age, comorbidity, disease status and previous treatment. The detection of SARS-COV2 in this cohort of patients made it possible to analyze the course of COVID-19, as well as to develop a strategy for the disease management of these patients. Aims: To assess the risk factors for the severe course of COVID-19, as well as to identify predictors of hospital mortality. Methods: 179 patients with verified CLL and COVID-19 were followed up by the hematology service of Moscow City Clinical Hospital No.52 (Moscow) from April 21, 2020 to November 31, 2021. Anthropometric, anamnestic, clinical and laboratory data were evaluated, treatment tactics of both CLL and COVID-19 were analyzed in 179 patients (69 women and 110 men, median age - 66 years). A statistical multivariate analysis of hospital mortality, factors of unfavorable prognosis of COVID-19 (complications, humoral response, hospital mortality) was carried out. Results: Age was a significant adverse factor for men: the age of a man from 73 years and more, increases the risk of death of the patient by 3.0 times (p<0.05). For women, age was not a significant adverse factor. Assessment of the effect of comorbidity: patients with 6 or more comorbidity scores according to Charlson have 2.2 times greater risk of death; the presence of cardiovascular diseases increases the risk of death of the patient by 2.3 times. The presence of 1 or more lines of chemotherapy in the anamnesis increased the risk of hospital mortality by 1.5 times. Patients who had previously undergone chemotherapy were treated until the moment of discharge statistically significantly longer than patients who had not undergone antitumor therapy. Relapse/progression of the disease was a factor of unfavorable prognosis for the survival of patients with CLL (mortality was 47% compared to 14.7% in patients in remission). A significant unfavorable prognosis is also the Binnet stage C (p<0.05). A valid factor in the failure of COVID-19 (p<0.05) was ICU therapy and the development of secondary bacterial complications (the use of 2nd-line antibacterial therapy). The assessment of the humoral response in 59 patients shows the presence of an increase in IgG on the 10th-14th days of the disease in 44% of patients, among whom no deaths were detected, 1/3 were vaccinated patients. The absence of a humoral response was a statistically significant adverse outcome factor in 25% of patients (p<0.05). Summary/Conclusion: Progression/recurrence of chronic lymphocytic leukemia is a factor in the severe course of COVID-19, and, as a result, increases the risk of hospital mortality. The absence of a humoral response determines the persistent course of COVID-19 and increases the risk of death by 25%. The study of the course of COVID-19 in patients with CLL allows us to identify key aspects affecting the choice of management tactics for this category of patients: additional booster vaccination (stimulation of the humoral response), early detection (screening) of SARS-COV2 for virus-neutralizing antibodies therapy, timely hospitalization of patients.